颈动脉血流速度与亚临床左心室舒张功能的关系——丹阳研究

Association between carotid blood flow velocity and left ventricular diastolic function—Danyang Study

摘要:

目的 颈动脉血流速度与左心室功能的关系尚不完全清楚，本研究旨在探讨颈动脉血流速度与亚临床左心室功能的关系。方法 研究对象为2021年在江苏省丹阳市车站社区招募的受试者。使用GE Vivid E90超声仪分析测量颈总动脉内中膜厚度(carotid intima-media thickness, cIMT)、颈动脉(颈总、颈内、颈外动脉)斑块及血流动力学参数，包括收缩期峰值流速(peak systolic velocity, PSV)和舒张末期血流速度(end diastolic velocity, EDV)。二维斑点追踪、二尖瓣口血流频谱和组织多普勒成像评估亚临床收缩功能[整体纵向应变(global longitudinal strain, GLS)]和舒张功能(E峰、E/A比值、e’和E/e’比值)。结果 研究纳入561名参与者，平均年龄(58.2±11.7)岁，其中女性339例(60.4%)，高血压214例(38.1%)。与左侧相比，右侧颈总动脉PSV、EDV更低。单因素相关分析显示: (1) 结构方面: 双侧颈总动脉PSV、EDV与左心室质量指数(left ventricular mass index, LVMI)和左心室肥厚(left ventricular hypertrophy, LVH)呈负相关(r为-0.362-0.145;P≤0.001)。(2) 收缩功能: 仅右侧PSV与LVEF正相关(r=0.091;P=0.036)，EDV与左心室整体纵向应变正相关(r=0.119;P=0.005)。(3) 舒张功能: 双侧PSV、EDV均与E峰、E/A比值、e’正相关(r为0.1710.476;P<0.001)，与E/e’比值负相关(r为-0.264-0.166;P<0.001))。在校正混杂因素后，仅PSV与E峰以及e’的相关性仍然具有统计学差异(r为0.1080.160;P≤0.011)，其余上述单因素观察到的显著相关均不显著或减弱。最后，进一步校正cIMT和颈动脉斑块后结果相似。结论 在丹阳社区自然人群中，颈动脉PSV降低与左心室亚临床舒张功能减退相关。

Abstract:

Objective To investigate the association between carotid blood flow velocity and left ventricular diastolic function. Methods A total of 561 volunteers were recruited from a community of Jiangsu Danyang City in 2021. The participants included 222 males(29.6%) and 339 females(60.4%) with an average age of （58.2±11.7） years, among whom 214 were hypertensive patients(38.1%). The carotid intima-media thickness(cIMT), plaque and blood flow velocity parameters of carotid artery(common carotid artery, internal and external carotid artery), including peak systolic velocity(PSV) and end diastolic velocity(EDV) were measured by GE Vivid E90 ultrasound instrument. 2D speckle tracking, mitral flow spectrum and tissue Doppler imaging were used to evaluate the systolic function(global longitudinal strain, GLS) and diastolic function(E peak, E/A ratio, e’, and E/e’ ratio). Results The PSV and EDV of the right common carotid artery were lower than those of the left side. Univariate correlation analysis showed that the PSV and EDV of bilateral common carotid arteries were negatively correlated with left ventricular mass index(LVMI) and left ventricular hypertrophy(LVH)(r=-0.362--0.14, P≤0.001); in the right side PSV was positively correlated with LVEF(r=0.091, P=0.036), EDV was positively associated with LVGLS(r=0.119, P=0.005); bilateral PSV and EDV were positively correlated with E peak, E/A ratio and e’(r=0.171-0.476, P<0.001), and were negatively correlated with E/e’ ratio(r=-0.264--0.166, P<0.001). After adjusting for confounding factors, only correlations of PSV with E peak and e’(r=0.108-0.160, P≤0.011) were still significant; further adjusted for cIMT and carotid plaque the similar results were obtained. Conclusion In the subclinical context the decreased carotid PSV is associated with left ventricular diastolic dysfunction.